Provider Demographics
NPI:1164809000
Name:FAVORS, VALERIE SMITH (PA-C)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:SMITH
Last Name:FAVORS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4665 MUSIC ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-5024
Mailing Address - Country:US
Mailing Address - Phone:803-637-1500
Mailing Address - Fax:803-637-7191
Practice Address - Street 1:3201 S CARROLLTON AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-4307
Practice Address - Country:US
Practice Address - Phone:504-207-3060
Practice Address - Fax:504-207-3067
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001005497363A00000X
LA303819363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant